On Personhood

In India, a girl with named Lakshmi just survived a surgery to remove four extra limbs. I’m glad to hear that she made it out ok, and it’s certainly a heartening story.

What particularly interests me about this case, though, is how it illustrates some of the problems with the anti-choice (and particularly Catholic and Evangelical Christian) conception of personhood. According to anti-choice ideology, life begins at the point of fertilization, and an embryo is not only human, but a unique human being deserving of all the rights endeared to you and I. Abortion, and even contraception, is murder because it terminates a unique human life.

The girl named Lakshmi is joined to a ”parasitic twin” that stopped developing in the mother’s womb. The surviving fetus absorbed the limbs, kidneys and other body parts of the undeveloped fetus.

So is Lakshmi one person, or two? How does the experience of this very real, born human being square with anti-choice ideology?

Obviously, I think it’s totally justified to remove Lakshmi’s parasitic twin. But the parallels with pregnancy are something to consider. And I wonder which logical hoops one would have to jump through in justifying the removal of a parasitic twin, but outlawing the removal of a fetus or embryo.

Q Grrl, I’m going to assume you’re being sarcastic here, but just as a quick response, Lakshmi couldn’t stand up or move with the parasitic twin still attached, and it was wreaking havoc on her body. I don’t think it’s possible that they could have waited until she was old enough to consent.

JPlum

November 7, 2007 at 1:58 pm

Q Grrl, she wasn’t going to survive until she was old enough to consent. This was a life-threatening condition.

M.

November 7, 2007 at 2:13 pm

Which logical hoops? It’s fairly easy to predict if you’ve spent any amount of time arguing with pro-lifers: “The fetus in the womb will become a fully functional human being someday whereas the parasitic twin will not.”

Given QGrrl’s past comments on issues raised by the surgeries on Ashley X and Katie Thorpe, I am guessing this is a not-so-subtle attack on the disability rights perspective.

I’d love to be wrong, though.

car

November 7, 2007 at 4:36 pm

You want a mind-bender on the concept of an individual, go listen to this story from a few years ago: human chimeras. It’s about what happens when those twins fuse very, very early in development. The link goes to NPR, with a short text summary if you can’t listen to the story. Came to light when a woman’s children didn’t match her genetically, because her ovaries were actually from the cell line of a fraternal twin who was absorbed in the first week or so of development. So, is she a murderer?

Mnemosyne

November 7, 2007 at 6:43 pm

It’s fairly easy to predict if you’ve spent any amount of time arguing with pro-lifers: “The fetus in the womb will become a fully functional human being someday whereas the parasitic twin will not.”

Uh, not quite. In fact, the pro-lifers took the other side, arguing that the doctors should not be allowed to separate the parasitic twin since it meant she would die, even though it meant a death sentence for the twin who might otherwise survive. So even when a conjoined twin outside of the womb had a chance to survive, pro-lifers wanted to deny her that chance.

But thanks for playing.

AAnon

November 7, 2007 at 6:56 pm

I think it’s *awesome* that the dialogue on this kind of issue can be so warped that nobody can figure out whether Q Grrl is serious or not. Issues of consent, agency, and autonomy mixed with, perhaps, disability rights . . . quite a combo.

We’re talking about extraneous tissue ruining the life of a child, and it’s actually an open question whether a criticism of removing the hindrance(s) is sarcastic. I can see the arguments playing out — “What is ‘normal’ anyway?” “What if it was just one extra limb?” “She should like herself the way she is!”

And yet, thankfully, in this case at least, reason wins out. Here’s hoping she recovers fully.

On a happier note, I can’t help cooing when I see that picture of baby Lakshmi. Total fountain-head ponytail!!

Mnemosyne

November 7, 2007 at 8:17 pm

I hate being in moderation ….

uPPLrDmb

November 8, 2007 at 1:18 am

so would having an extra toe or finger be in violoation?

it was an extra body part, prior potential human or not.

people get kidneys replaced, does that mean the donor is violating these issues as well?
quit looking so indepth into things.

she might have not lived long enough to give consent on removing the parts.

if i was 12 and had extra arms and legs, i would have wished that they were removed when i was younger instead waiting so long.

the child couldn’t walk!… think about that.

Morningstar

November 8, 2007 at 1:36 am

Obviously, I think it’s totally justified to remove Lakshmi’s parasitic twin. But the parallels with pregnancy are something to consider. And I wonder which logical hoops one would have to jump through in justifying the removal of a parasitic twin, but outlawing the removal of a fetus or embryo.

I see what you’re saying, but you’re not really suggesting a fetus is parasitic, are you?

According to anti-choice ideology, life begins at the point of fertilization, and an embryo is not only human, but a unique human being

Reminds me of an argument I got into with a pro-forced pregnancy dude who went on about the unique genetic identity of an embryo, and how that unique combination will never occur again and blah blah blah fetus magic.

What about identical twins? They don’t have unique genetic identities. Is it okay to abort one of them?

piny

November 8, 2007 at 3:45 am

Wow, I can’t imagine how increadibly painful it must be to recover from having two arms, two legs, kidneys, and fused vertebrae removed from your body.

Shouldn’t they have waited until the child was old enough to consent? Who made this choice for her? Her parents?

How cruel! How selfish of them – especially considering how many others felt she was a reincarnation of a goddess.

It is absolutely an attack on the disability-rights perspective–you know, the one that has qualms about comparing menarche to Lakshmi’s pre-operative condition. Q apparently thinks that disabled women who have a problem with a trend towards hysterectomies for the sake of easier care might as well be Christian Scientists.

Lorelei

November 8, 2007 at 4:18 am

guys i’m having some doubts about qqrrl being genuine. a quick google of her name and ‘feminist’ will bring up a bunch of comments by her on feminist blogs where she makes feminist statements.

Tom

November 8, 2007 at 5:09 am

I don’t know that the pro-life crowd would have an issue with it per se. A developing fetus has the potential of developing into a person. The parasitic twin in this case is essentially vestigial tissue left over from a fetus that never did and never will develop into a full person as such. Does anyone know if they have an issue with extracting a stillbirth?

And regarding the conjoined (NOT parasitic) twin case that Mnemosyne linked to, that was a case of conjoined twins that were already six weeks old. The surgery in that case killed the weaker twin. Not the same issue, killing someone already born, rather than in this case simply removing vestigial tissue.

I don’t know that the pro-life crowd would have an issue with it per se. A developing fetus has the potential of developing into a person. The parasitic twin in this case is essentially vestigial tissue left over from a fetus that never did and never will develop into a full person as such. Does anyone know if they have an issue with extracting a stillbirth?

No, but I do know that they have issues with terminating pregnancies that will never result in a living human being — see ectopic pregnancies and anencephaly. In other cases of parasitic twins, the parasite has still been technically alive — so I wonder how that squares.

I’ve never felt that comfortable engaging in debates about the personhood of a fetus or an embryo for many reasons, but mostly because it isn’t relevent to a reproductive rights discussion. No person has the inalienable right to to live within and feed off of the body of another without their consent.
but I think talking about it in this context trivializes some serious theological and moral questions that Lakshmi and her family are facing. In the case of Menar Magad, which is a lot more complicated because her twin had a brain and eyes and face, her family made the decision to treat the twin as a person and to bury it (her, I suppose) in a cemetary with a headstone and a name.
Does that fact that, unlike Menar’s twin, Lakshmi’s had not conciouness and couldn’t cry or smile, make it a different situation? Does it matter? Lakshmi would have died without this surgery and even if her parasitice twin was a person that doesn’t give it slowly kill Lakshmi.

What does she lose from pregnancy? And I’m talking normal, healthy pregnancy here, because you’re saying all fetuses are parasites.

It’s a symbiotic, neither harmful nor beneficial relationship.

But since you asked, for some women, there’s an end to seasonal allergies, improved sexual function, an end to mild acne, and increased REM sleep.

In fact, like it or not, for most women, pregnancy is pretty manageable.

Dianne

November 8, 2007 at 11:07 am

What does she lose from pregnancy? And I’m talking normal, healthy pregnancy here, because you’re saying all fetuses are parasites.

On the most basic level, food and oxygen, both of which the fetus takes from her body as it needs to grow, without giving her anything she needs to survive in return. That the fetus may do no serious or lasting damage is not relevant. A tapeworm living in a person’s intestines may peacefully absorb a few nutrients, lay its eggs, and pass out of ther body through the colon without doing any serious harm. It’s still a parasite.

It’s a symbiotic, neither harmful nor beneficial relationship.

That’s not the definition of a “symbiotic relationship”. For a relationship to be symbiotic, it must be of benefit to both parties. The woman receives no direct benefit from the fetus, though evolutionarily one could question whether a relationship that ends with her genes being transmitted is turly “parasitic” either.

Mercredi

November 8, 2007 at 11:13 am

Does anyone know if they have an issue with extracting a stillbirth?

Some of them do. I’ve read of an instance where a Catholic hospital refused to allow the removal a dead fetus from the mother at their facility unless she was hemorrhaging. (It should be noted that the woman’s doctor disagreed strenuously, and helped her find a place willing to perform the procedure.)

I’m not sure if that’s consistent with Official Catholic Doctrine re: stillbirth or not, but it’s evidence that at least one anti-abortion group objects to the removal of already-dead fetuses from their mothers.

antiprincess

November 8, 2007 at 11:36 am

eh. pregnancy feels pretty parasitic to me, at the moment (five and a half months along). I’ve heard some women dig being pregnant. I’m not one of them. I’m tired and achy and just got out of the “I want to die” phase. I can’t sleep. I’m fretful and unpleasant to be around. and, as a friend of mine said the other day, it feels like I’ve swallowed an eel. so, count me as one who doesn’t feel tremendously symbiotic. (but that’s just one opinion. I’m NOT every woman.)

re: Qgrrl, Lakshmi, the disability-rights perspective: I think there’s a difference between surgery that makes the parent feel better and surgery that makes the child feel better. removing a healthy uterus (which wouldn’t kill Katie) is different than removing parts of an unseparated twin (which would kill Lakshmi).

of course, this is not to say that I don’t see the ambiguity in determining bodily integrity.

guys i’m having some doubts about qqrrl being genuine. a quick google of her name and ‘feminist’ will bring up a bunch of comments by her on feminist blogs where she makes feminist statements.

What, you’ve never met self-professed feminists who suck on other issues?

Sadly, there’s a whole bunch of them in the disability-rights arena.

Q Grrl

November 8, 2007 at 11:49 am

It wasn’t an attack against disability rights. Against those who think they now where and how to draw the lines, yes. The barb was towards thou.

The picture of Lakshmi above is preoperative: the one soooo cute ovaries are twitching!

What the picture doesn’t show is that Lakshmi didn’t just have “four arms and four legs”. She was a conjoined twin. The photocrop doesn’t show her twin. Just her, as if her extra limbs had been attached (and then removed) from a rather normative structural location. But that wasn’t the case. Lakshmi had a twin, albeit not one that the medical community liked, that was fused from what appears to be the lower sacrum.

Yesterday I could find a photo of her on-line, preoperative, that showed the twin. Today I can only find a better version of the photo cropped for this post – which shows the twin’s legs and arms, but still obscures the full body of the twin, which was equivalent in size to Lakshmi’s body.

My issue was that it appeared to me that Jill’s radar was off. I don’t see this as an opportunity to criticize the Right’s weird abortion stances. I see the logical comparisons to autonomy, choice, consent, etc., that have come up in previous discussions about disability rights.

I have yet to read the details of how her conjoined twin was life threatening.

And regarding the conjoined (NOT parasitic) twin case that Mnemosyne linked to, that was a case of conjoined twins that were already six weeks old. The surgery in that case killed the weaker twin. Not the same issue, killing someone already born, rather than in this case simply removing vestigial tissue.

One twin was parasitic on the other; she would be completely unable to survive without being attached to her sister, but her sister’s body was unable to support both of them. The doctors had a choice: separate the twins and kill one, or leave them attached and kill both. Not all conjoined twins are parasitic, but one conjoined twin can be parasitic on the other twin. That’s why they have to evaluate separations very carefully and can’t just whack them apart willy-nilly.

Interesting that you think it’s better to kill two people than to take a chance that will allow one to survive, even if it means the death of the other. I guess that explains why pro-lifers would rather let women like Olga Reyes die than remove the embryo that ended up killing her. Better certain death than possible survival, right?

QGrrl, I saw that picture. You haven’t changed my mind; the fountain-head ponytail is adorable, and she’s a cutie-pie.

It alarms me that you see this as being analogous to forced sterilization. One article describes Lakshmi’s situation as follows: “Dipygus parasiticus cases, http://www.phreeque.com reported, have imperfectly developed legs joined to the pelvis or lower spine. A person with dipygus parasiticus case may not have total control over his limbs, which may be extra hands or feet. However, he cannot move them individually. He may also have extra breasts, or other body parts.”

Another article says: “Lakshmi cannot stand or walk and she has merged spines, four kidneys, entangled nerves, two stomach cavities and two chest cavities.”

Finally, this article says: “Doctors say the surgery will give Lakshmi a good chance to live past adolescence.” From that I take it that without the surgery, Lakshmi would or might not have lived past adolescence.

Lakshmi had a twin, albeit not one that the medical community liked, that was fused from what appears to be the lower sacrum.

Uh, the other twin had no head, much less a brain. Kinda hard to argue that it’s a completely separate entity that has rights of its own the way people argued in the Mary/Jodie case I referenced. However, I do think that the Mary/Jodie case was decided correctly because, as we have stated many times, no one has the right to use someone else’s body to sustain their own life.

And when you have to insert a tube into the stump of where the neck would be so that Lakshmi can urinate, I think that’s a pretty good indicator that she would die without having the other tissue removed. Not being able to urinate or defecate is a much more serious problem than people think.

antiprincess

November 8, 2007 at 12:11 pm

Against those who think they now where and how to draw the lines, yes. The barb was towards thou.

so the comment had nothing to do with the issue, but was designed simply to make people you disagree with look silly?

do you think it worked?

for what it’s worth, I think you raise a good point – that it’s not always easy to draw the line. there’s plenty of ambiguity. But being “barbed” doesn’t make the ambiguity go away, nor does it make the issues any easier to discuss.

Sepra

November 8, 2007 at 12:35 pm

Yesterday I could find a photo of her on-line, preoperative, that showed the twin. Today I can only find a better version of the photo cropped for this post – which shows the twin’s legs and arms, but still obscures the full body of the twin, which was equivalent in size to Lakshmi’s body.

I found the picture of her with the twin pre-op on a Google search that lasted 5 seconds. It was the first link.

My issue was that it appeared to me that Jill’s radar was off. I don’t see this as an opportunity to criticize the Right’s weird abortion stances. I see the logical comparisons to autonomy, choice, consent, etc., that have come up in previous discussions about disability rights.

Sure — but a case can bring up various different issues, right? I mean, does it have to be repro rights OR disability rights? I focused on something I found interesting. Doesn’t mean that there aren’t any other issues to address.

And as others have said, it is hard to draw lines and there is ambiguity. But this isn’t a case about performing an unnecessary surgery in order to make someone else more comfortable. It’s about saving this little girl’s life and health, and enabling greater mobility.

I understand these conversations get heated, but I don’t see why you find it necessary to show up on this thread and try to piss everyone off. We can have a conversation, but throwing barbs out because you’re still angry about a thread from a month ago is pretty out of line.

Blitzgal

November 8, 2007 at 12:42 pm

I *just* had a similar conversation about this story with a couple of friends. We were talking more on a spiritual level, though. This case brings up interesting questions on a religious level regarding possession of a soul. Clearly these two were at one point separate entities inside their mother’s body. So did they both have souls at that point? And when one twin naturally subsumes the other, what happened to the other twin’s soul? And from a religious perspective, did they ostensibly kill someone by removing the parasitic twin? (I don’t believe so, but issues like this is why I’m firmly agnostic)

It’s interesting because prior to the mid-nineteenth century, the Church’s stance on unborn children was that they did not possess a soul until the moment of quickening, or when the fetus was felt to move inside the woman’s womb. That normally doesn’t occur until late in the fourth month or early fifth month of pregnancy. Interesting how the current pro-life belief that life begins at conception isn’t even more than 150 years old, huh?

Kristen from MA

November 8, 2007 at 12:47 pm

In fact, like it or not, for most women, pregnancy is pretty manageable.

Speak for yourself. You’re not even considering the effects on a woman’s mentalhealth.

Tom

November 8, 2007 at 12:49 pm

Mnemosyne said:

Interesting that you think it’s better to kill two people than to take a chance that will allow one to survive, even if it means the death of the other. I guess that explains why pro-lifers would rather let women like Olga Reyes die than remove the embryo that ended up killing her. Better certain death than possible survival, right?

Actually, no, I don’t think that. I think that the British court in fact decided the case correctly, coming to a, literally in that case, Solomonic, decision. Regrettably, It still meant killing a person, but it meant saving another.

But the difference in this case, which you point to in a later post, is that in Lakshmi’s case, the parasitic twin didn’t have a head. There is no argument that the parasite was in fact ever alive as a separate person. Pointing out the distinctions between these two cases serves to highlight that a decision on one would not necessarily be the same as a decision about the other, not as an indicator of what I think.

Incidentally, though, what I think is that having these debates on technical points regarding bioethics is important, and prevents us from coming to some pretty ugly places regarding decisions about human life. It’s the people who want to elide the finer points of those debates who worry me.

preying mantis

November 8, 2007 at 12:50 pm

“It’s a symbiotic, neither harmful nor beneficial relationship.”

Tell that to the women who used to (and in particularly poor areas of the globe, still do) lose teeth from normal, healthy pregnancies due to the fetus hijacking too many nutrients. You either cater to the fetus’s demand for extra nutritional and caloric intake during pregnancy, or you can suffer a deficiency yourself. The fetus takes what it needs first. You know, like a parasite.

Morningstar

November 8, 2007 at 1:18 pm

I had a response all typed out but the board got disconnected or something, so here we try again:

On the most basic level, food and oxygen, both of which the fetus takes from her body as it needs to grow, without giving her anything she needs to survive in return. That the fetus may do no serious or lasting damage is not relevant. A tapeworm living in a person’s intestines may peacefully absorb a few nutrients, lay its eggs, and pass out of ther body through the colon without doing any serious harm. It’s still a parasite.

A simple way to determine if something is parasitic or not is:

a) is a different species invading the host?

b) does the host produce antibodies against the organism?

no and no. In fact, the reality is that every month, a woman’s body works hard to create ripe conditions for a fertilization. And once an egg is fertilized, the woman’s body does all sorts of amazing things to keep that embryo alive.

The woman receives no direct benefit from the fetus

I listed several benefits woman can get from pregnancies.

though evolutionarily one could question whether a relationship that ends with her genes being transmitted is turly “parasitic” either.

Of course it’s not. So why are we even arguing this?

Michelle

November 8, 2007 at 1:22 pm

Nearly 6 months along here, and add me to the list that finds pregnancy parasitic. In fact, in our house we refer to this little one as “the parasite” “thumper” “the rutabaga” etc.

A highly desired parasite is still a parasite! Last year at this time I ran a marathon. Pregnant, I still exercise, but I can’t run, and I get winded climbing stairs. My back hurts. I have to be careful to get enough calcium if I want to keep my own teeth and bone density. I have trouble sleeping. For 4 months I wanted to die from nausea, and had trouble getting through the work day. I could go on (and on) but that’s the idea.

To me it’s worth the trouble because I *CHOSE* to get pregnant and to begin this whole process. But being pregnant has made me more sure than ever that NO ONE should go through this who doesn’t whole-heartedly want to!

Entomologista

November 8, 2007 at 1:22 pm

What definition of “parasite” are you using?

It’s a symbiotic relationship.

Let’s have a little biology lesson, shall we? Symbiosis is a relationship between two or more organisms of a different species. The relationship may be defined as mutualism, commensalism, parasitism, or neutral. It is possible to argue that the mother benefits from the fetus by passing on her genes, but there are also many negative effects of pregnancy. However, the fetus obviously gains quite a lot from the mother. In reality, I wouldn’t define the fetus-mother relationship as any of these things because they are of the same species and sexual reproduction is different from ecological interactions. But just because it isn’t literally parasitism doesn’t mean that pregnancy doesn’t suck. The only reason pregnancy exists as it does is because evolution only creates systems that are good enough to pass genes on in the current environment.

But let’s continue with the lesson just because this stuff is cool:

I’m sure we’ve all heard of mutualism through ants and acacia or sharks and cleaner fish.

A commensal relationship is one where one organism benefits but the other is not significantly affected. An example of this might be a botfly laying an egg on a mosquito so that it can be transported to the host.

There are different kinds of parasites. Some are obligate, others are not. Some are obligate during some life stages and independent during others. Some are parasitoids, with the end result always being host death – most wasps fit this category – others are parasites where host death is not the usual result or goal- a good example is pinworms. Parasites can live everywhere from the surface of your body, to your brain, your digestive system, your respiratory system, your lymph system, to inside your cells. They can even influence behavior. Parasites are the best.

Q Grrl

November 8, 2007 at 1:31 pm

Interesting that you think it’s better to kill two people than to take a chance that will allow one to survive, even if it means the death of the other.

I don’t believe I’ve given my opinion to the rightness or wrongness of the choice. Lakshmi will die eventually, as will we all. My opinions, which I have not stated, stem from a quality-of-life perspective (and who has the autonomy/authority to make those decisions).

Rachel:

It alarms me that you see this as being analogous to forced sterilization.

I don’t.

Jill: you are right about my thrown barb. My selfish hope when I first saw this story, prior to your post, was that it would be incorporated into the feminist discussions of disability rights. I hadn’t thought of it as a reproductive rights issue, and still don’t clearly see that angle.

Morningstar

November 8, 2007 at 1:35 pm

Thanks for clarifying those terms. It was clumsy to say it was “symbiotic” but but I’m glad you said it can’t be defined as parasitic either.

EG

November 8, 2007 at 1:36 pm

does the host produce antibodies against the organism?

If a mother is Rh- and her first child is Rh+, her body will indeed produce antibodies to Rh, attacking any subsequent pregnancies with Rh+ fetuses.

Yeah, symbiosis = mutual benefit. I’ll eat your parasites for sustenance, and you’ll get clean if you just let me rest on you back a while.

Pregnancy is not symbiotic. At best it’s neutral. I don’t see why parasitic relationships are necessarily bad, though. In most cases, yes, a parasite is a bad thing because it lives at the expense of its host. Babies are temporary, and hardly harmful, but I’m not going to say they’re relationship to their mothers in utero isn’t parasitic just because it has negative connotations.

$.02

Entomologista

November 8, 2007 at 1:48 pm

If a mother is Rh- and her first child is Rh+, her body will indeed produce antibodies to Rh, attacking any subsequent pregnancies with Rh+ fetuses.

Yep. Thanks for pointing this out. But like I was saying ealier, our systems are only good enough. Which is why stuff like this happens. But not all parasites illicit an immune response, as far as I’m aware.

Anyway, just because I don’t think the technical definition of parasite applies to a fetus doesn’t mean that I think pregnancy is a totally wonderful thing that all women need to go through.

Dianne

November 8, 2007 at 1:50 pm

does the host produce antibodies against the organism?

The host doesn’t produce antibodies against prions, most cancer cells, and a few very well adapted viruses/parasites/bacteria as well. On the other hand, people can, quite often, produce antibodies against their own bodies, so does that mean that they are self-parasitic? Not to mention that the main reason that people don’t make antibodies to fetuses is that they produce immunosuppressive chemicals to prevent it. A common defense mechanism for parasites.

I listed several benefits woman can get from pregnancies.

Yeah, and they were all BS. Brain tumors also produce a reduction in allergic symptoms. Does that make it healthy to have a brain tumor? There is no real benefit to pregnancy except that it is the only way to produce an offspring. Pregnancies that do not result in offspring are beneficial for neither the organism nor the gene.

Ashley

November 8, 2007 at 1:51 pm

There are also other autoimmune disorders that cause women to miscarry repeatedly. I think lupus and Factor V Leiden are some.

Morningstar

November 8, 2007 at 2:01 pm

If a mother is Rh- and her first child is Rh+, her body will indeed produce antibodies to Rh, attacking any subsequent pregnancies with Rh+ fetuses.

We’re talking the norm here, not the exception.

This is getting ridiculous.

Morningstar

November 8, 2007 at 2:03 pm

Anyway, just because I don’t think the technical definition of parasite applies to a fetus doesn’t mean that I think pregnancy is a totally wonderful thing that all women need to go through.

Just to clarify since this is the second time you said this: I didn’t say that it was a wonderful thing that all women need to go through.

I said that by and large it’s pretty manageable for most women, that a woman’s body is adapted for fetuses, and that there are in fact some benefits to pregnancies.

Dianne

November 8, 2007 at 2:26 pm

I said that by and large it’s pretty manageable for most women,

Err…sort of. Actually, reproduction is a real weak point for humans, little as you might think it by how many of us there are. In parts of Afghanistan where there is basically no medical care, the mortality from pregnancy and childbirth is 6% per pregnancy. Needless to say, given that birth control options are also minimal, lots of women die of pregnancy related complications. True, 94% survive (many with rectovaginal fistulas and other problems), but that’s a pretty high mortality for something that you’re claiming is “pretty managable.”

that a woman’s body is adapted for fetuses,

So-so. The cervix dilates to 10 cm. The average fetal head is 11 cm. It works, sort of, enough of the time, but that doesn’t make it easy or, really, all that good an adaptation. Probably humans would have evolved a better adaptation (larger pelvises? earlier births?) if technology hadn’t intervened, but I’m happy to let our technology correct for any poorly evolved bits at this point.

and that there are in fact some benefits to pregnancies.

So? One can also benefit from tapeworm infection–weight loss, you know. Seasonal allergies (and some autoimmune diseases) decrease during pregnancy because of immunosuppression–not a good thing overall even if it is nice to be able to get through the occasional spring without sneezing continually. More REM sleep comes with excess fatigue, again a minor side benefit to a major inconvenience and potential risk. I’ve never actually heard of anyone having improved sexual function during pregnancy. Sounds nice but hardly an overwhelming biological advantage.

Dianne

November 8, 2007 at 2:27 pm

The bottom line is that human reproduction is a huge mess, far worse than for most animals or even most mammals and far too risky to be forced on an unwilling person.

Mnemosyne

November 8, 2007 at 2:34 pm

We’re talking the norm here, not the exception.

This is getting ridiculous.

You weren’t coming across as talking about the norm. You were coming across as insisting that there is no similarity at all between a fetus and a parasite when there are, in fact, many similarities. Pretending those similarities don’t exist at all when they clearly do is, well, ridiculous.

Pregnancy is a much more oddball process than a lot of people realize. Chimeras are not uncommon. We now know that there are three kinds of twins: fraternal, identical, and semi-identical. Intersexed children are common enough that their treatment is under some pretty serious debate.

Personally, I find it pretty cool to discover that pregnancy is not the all-or-nothing, all-good or all-bad process that people seem to think it is, but YMMV.

I don’t know how to answer your question about parasitic twins and their removal, but I’ll instead share with you my story, and maybe have an answer for you at the end.

I am pro-choice. I’m also infertile and underwent IVF. I can tell you, seeing those follicles, and later, those embryos, on the screen was one of the most amazing moments in my life. Those little bits of potential, of life…no, I don’t believe they are aware, not at that age. However, for me the hypothetical child became ‘real’ around 6w, when I heard the heart beat and experienced some bleeding.

This is my first, and might be my only pregnancy. If there were a parasitic twin, no, I would not terminate unless the other baby would have no chance at life after birth (those of you who know Ann’s story will understand the heartbreak of having to make that choice). A parasitic twin might give extra bits, but that is not, imo, a good reason to terminate. Besides, doesn’t that come down to mere prejudice, no other good reason?

Mnemosyne

November 8, 2007 at 2:41 pm

Actually, no, I don’t think that.

I think I got you and M. slightly mixed up — M. was the one claiming that pro-life people would automatically recognize that a parasitic conjoined twin couldn’t become a fully functional human being, which is why I brought up the case of Mary/Jodie. Which is the kind of case I can only pray I never have to make a personal decision about: “So, do you want both of your children to die, or only one?”

Nearly 6 months along here, and add me to the list that finds pregnancy parasitic. In fact, in our house we refer to this little one as “the parasite” “thumper” “the rutabaga” etc.

My parents still call a parasite – and I earn my own living these days. Heh heh.

Mnemosyne

November 8, 2007 at 2:46 pm

If there were a parasitic twin, no, I would not terminate unless the other baby would have no chance at life after birth (those of you who know Ann’s story will understand the heartbreak of having to make that choice). A parasitic twin might give extra bits, but that is not, imo, a good reason to terminate. Besides, doesn’t that come down to mere prejudice, no other good reason?

I don’t think anyone was arguing that Lakshmi’s mother should have terminated the pregnancy altogether, especially since we were all cooing about how cute she is. As they said on MST3K, that kid is aggressively cute.

It’s more a question of how pro-life people view the fact that Lakshmi was born essentially as one-and-a-half people. Does the parasitic twin have a soul even if it doesn’t have a head or brain?

estraven

November 8, 2007 at 3:08 pm

Michelle said:

being pregnant has made me more sure than ever that NO ONE should go through this who doesn’t whole-heartedly want to!

I had two pregnancies. I chose to have them, loved (almost) every minute of them, and I am sorry that due to a number of very good reasons I will never have another.
And I totally, completely agree with you. Being pregnant has made me aggressively pro-choice.

I’ve never actually heard of anyone having improved sexual function during pregnancy.

This is just an aside – but I definitely have. And an improved sex-life after birth (provided both birth and the recovery period go well).

My grandma actually talks about this stuff all the time in relation to her relationship to granddad… Which is total TMI of course, from where I stand, but she’s a retired physician and doesn’t feel weird about it.

being pregnant has made me more sure than ever that NO ONE should go through this who doesn’t whole-heartedly want to!

Haven’t been pregnant (though I want to be, later in life) – I came to that conclusion when my mom had my brother. I was already 11 at the time, and yeah… My mom is one of those people who was blessed to have two relatively easy pregnancies, and she had the whole “glow” thing going as well (and had herself photographed all the time – and the photographs are amazing)… And still. She was honest with me about things (and more honest later, when I was old enough). I was in 6th grade, and pro-choice all the way.

It just really hit home for me. The evil of being forced to be pregnant.

Seraph

November 8, 2007 at 3:48 pm

Morningstar, I’d like to compare the benefits you offered:

But since you asked, for some women, there’s an end to seasonal allergies, improved sexual function, an end to mild acne, and increased REM sleep.

Personally, I would have to ask if those benefits are provided by the fetus itself, or the hormonal and physical changes of pregnancy. That is to say, the mother’s own body as it provides a more hospitable host for the fetus. If the answer is the latter, then the relationship can’t be said to be mutualistic. Is it, then, commensalistic by entomologista’s definition, or perhaps neutral?

To answer that, let’s compare your benefits to some of the examples of damage inflicted on the mother in return:

What does she lose from pregnancy? And I’m talking normal, healthy pregnancy here, because you’re saying all fetuses are parasites.

On the most basic level, food and oxygen, both of which the fetus takes from her body as it needs to grow, without giving her anything she needs to survive in return.

Tell that to the women who used to (and in particularly poor areas of the globe, still do) lose teeth from normal, healthy pregnancies due to the fetus hijacking too many nutrients. You either cater to the fetus’s demand for extra nutritional and caloric intake during pregnancy, or you can suffer a deficiency yourself. The fetus takes what it needs first. You know, like a parasite.

A highly desired parasite is still a parasite! Last year at this time I ran a marathon. Pregnant, I still exercise, but I can’t run, and I get winded climbing stairs. My back hurts. I have to be careful to get enough calcium if I want to keep my own teeth and bone density. I have trouble sleeping. For 4 months I wanted to die from nausea, and had trouble getting through the work day. I could go on (and on) but that’s the idea.

Also, to counter this assertion:

A simple way to determine if something is parasitic or not is:

a) is a different species invading the host?

b) does the host produce antibodies against the organism?

Entomologista points out:

But not all parasites illicit an immune response, as far as I’m aware.

With all of that in mind, a fetus misses the dictionary definition of a parasite only by virtue of being the same species as the host. It’s still a separate organism that can’t survive without stealing what it needs from its host, causing harm to the host in the process.

Remember, when you say this:

that a woman’s body is adapted for fetuses

That evolution operates on a “good enough” basis. If most women survive the experience (or at least their offspring do), then it stays in. People can be “adapted” for something that causes a whole lot of misery, or even damage.

alsojill

November 8, 2007 at 3:57 pm

We’re talking the norm here, not the exception.

Um, speaking as a woman with Rh- blood, which I inherited from my mother, who had no children after my Rh+ brother b/c of this issue, I would like to argue that this is not an “exception.” Rh- blood is not an uncommon thing to have, and most women don’t go around screening potential sperm donors/husbands/etc. to make sure they don’t run the risk of carrying a child that would have Rh+ blood. So I object to the idea of its being an “exception.” It’s a normal and risky part of pregnancy.

DDay

November 8, 2007 at 3:59 pm

I have nothing constructive really to add other than that child is insanely adorable.

As a married man who hopes to someday have kids, two-year-old Lakshmi Tatma is pretty much my worst nightmare. Not because she was born with four extra limbs from an unborn twin attached at her pelvis. And not because the operation that doctors are about to perform to remove the limbs is elaborate and potentially life threatening.
No, Lakshmi Tatma is my worst nightmare because, spiderlimbs or no, she’s so fantastically adorable that were I her father, I would clearly cater slavishly to her every whim till the day I died.

Dianne

November 8, 2007 at 4:43 pm

Rh- blood is not an uncommon thing to have,

IIRC, about 15% of European descended women are Rh-. So, technically, they are an “exception” if by exception you mean anything that occurs in less than half the population. But we (I’m also Rh-) are by no means the rare mutants that Morningside’s dismissal seems to suggest.

Seraph

November 8, 2007 at 5:08 pm

I’ve never actually heard of anyone having improved sexual function during pregnancy.

I have. Hormonal questions aside (and I admit, setting them aside during pregnancy is foolish at best), I understand that it’s due to the increased bloodflow to the ladybits. More or less continuous hard-on (I think the term applies in this situation). Biologists? That anywhere close to right?

Sounds nice but hardly an overwhelming biological advantage.

And the “end to mild acne” even less so.

Ledasmom

November 8, 2007 at 5:34 pm

I’ve never actually heard of anyone having improved sexual function during pregnancy

Oooh, yes. As in all the time.

A simple way to determine if something is parasitic or not is:

a) is a different species invading the host?

b) does the host produce antibodies against the organism?

Aren’t male anglerfish referred to as “parasitic”, despite being of the same species as the female?

Cyan

November 8, 2007 at 6:29 pm

Warning: tangent ahead.

“The average fetal head is 11 cm. It works, sort of, enough of the time, but that doesn’t make it easy or, really, all that good an adaptation. Probably humans would have evolved a better adaptation (larger pelvises? earlier births?) if technology hadn’t intervened, but I’m happy to let our technology correct for any poorly evolved bits at this point.”

Technology isn’t the reason why human births are exceptionally prone to complications. Evolution produces selective pressure for big brains (for thinking) and narrow hips (for efficiency of upright motion). We’ve got as short a gestation time as we can manage, but beyond that, the conflict leads to a trade-off between the evolutionary benefits of surviving childbirth while having hips narrow enough to walk/run efficiently and the evolutionary benefits of having children with big brains. Evolution is amoral, and women suffer and die because of it.

Psychobunny

November 8, 2007 at 7:16 pm

#43 – it’s not a problem limited to “poorer” countries either – my boyfriend’s mother had a full set of falsie teeth after her third pregnancy. Congenital calcium deficiency + pregnancy = awful dental problems.

alsojill

November 8, 2007 at 8:37 pm

IIRC, about 15% of European descended women are Rh-.

Huh. I didn’t know that. I have a relatively rare blood type (shows up in something like 9% of the world’s population–and my Rh+ brother’s is even more rare), but had rather naively assumed that the more common blood types would be more evenly divided, RH-wise. Interesting.

Amanda

November 8, 2007 at 8:51 pm

From askoxford.com:
parasite

• noun 1 an organism which lives in or on another organism and benefits at the other’s expense

A fetus is an organism, as is the mother, so the first qualification is definitely met. The fetus obviously benefits, as it would not even be alive were it not for the fact that it was living in the mother. The mother suffers (in most cases) from fatigue, nausea, weight gain, etc. The list goes on and on.

It’s not just Rh+/- either. ABO mismatches can also cause the mother to develop antibodies; they’re just not as aggressive as the ones for Rh (says the woman who had an ABO mismatch with her mother).

Also, you’re really not going to sell me on the positive health benefits of pregnancy as I sit here with a hip that spasming because of damage done by a pregnancy for a child that’s now nine years old.

pram in the hall

November 8, 2007 at 9:47 pm

No one should be forced to support the life of another human with her body, though it can be lovely when she chooses to do so. I’m another for whom pregnancy (3 of them) strengthened pro-choice beliefs. And while I know pregnancy is a walk in the park for some, in my first two pregnancies I had hyperemesis (excessive vomiting that went on for about 5 months) that involved multiple hospitalizations. In my third my third, which was unplanned, I had severe anemia and depression. Knowing I chose to carry the pregnancy made the symptoms bearable. I cannot imagine forcing those conditions on anyone.

Lakshmi should not be forced to suffer for a parasitic “twin.” Not to do the surgery is forcing her to support the twin–if you consider something without a head to be a person. If her health were not jeopardized, one might make a case for waiting until she could consent, but we make all kinds of medical decisions for those who cannot do so themselves. I think we usually base them on how we ourselves would prefer to be treated.

If it were possible, how many prolifers would be willing to be hooked up to the twin in Lakshmi’s place? How many would have been willing to be hooked up to Jodie (post #8)?

Mnemosyne said: It’s more a question of how pro-life people view the fact that Lakshmi was born essentially as one-and-a-half people. Does the parasitic twin have a soul even if it doesn’t have a head or brain?

My brain ‘splodey.

I guess it depends on whether you believe in soul as ‘this organism is part of the Universe’ or soul as ‘going to heaven after death’. I’m a pagan, so for me it’s the former, y’know, body and soul return from whence they came, there is no…loss, if you will? I don’t know how to explain it, sorry.

And really, Lakshmi really s aggressively cute, you could just eat her up with a spoon.

zuzu

November 9, 2007 at 2:38 am

I don’t think anyone was arguing that Lakshmi’s mother should have terminated the pregnancy altogether

And here’s the thing: we’re analyzing this from a Western, heavily Christian-influenced framework. I know we have Indian readers (and guest-bloggers), and I’d love to hear from them. My understanding, which may well be imperfect, is that Hinduism really doesn’t have any particular issue with abortion.

In any event, Lakshmi’s parents, who are from a small village, may very well have had no idea that there was a parasitic twin involved. I mean, my mother, back in 1970, had no idea she was having twins because medical science back then was limited to feel and hearing — and since the doctor could feel only one head and one trunk, and hear what sounded like a big baby with an echo, he was fairly confident that it was a big baby with an echo. I’m somewhat skeptical that, despite technological breakthroughs since1970, residents of a small village in India would have those consistently available and affordable.

In any event, it appears from the photos that her parents are very loving and attentive, and from what I’ve read, she’s been accepted from day one in the village as the reincarnation of a goddess. I shudder to think how she’d have been accepted among the god-bothering crowd had she been born into a community in the US that viewed deformity as the mark of the devil.

I’m actually confused by Q Grrl’s comment. Essentially, you seem to be arguing that no child should ever undergo surgery until she is old enough to give meaningful consent. I don’t see how that is good for feminism, and I don’t really see how it impacts on disability rights one way or another.

(Personally, I think that any feminism that is at the expense of disability rights is a contradiction in terms, since the majority of disabled people are women, and around 10 to 20% of women are disabled. But I don’t see how Q Grrl’s rather extreme position is an example of that kind of feminism.)

My grandmother’s best friend was an early pioneer of paediatric surgery in the UK. I think most of the problems she faced in getting her ideas accepted were to do with people thinking of children as dispensable, so there was no point performing surgery on them. Or very fragile, so they couldn’t possibly survive being cut up. I don’t think that back then public opinion was very worried about whether children could give consent to the procedures, but perhaps that was a factor too.

antiprincess

November 9, 2007 at 10:48 am

individ-ewe-al — I think QGrrl is trying to make a reference to an earlier issue involving the question of a hysterectomy performed on a girl who is bedridden, with severe disabilities, in order to avoid menstrual issues and possible pregnancies.

Some folks were pro-surgery in that case, some were not. I think QGrrl is trying to reducto-ad-absurdum the anti-surgery position, in order to make proponents of the anti-surgery argument look silly.

which, you know, she’s entitled to her opinion and needs no one’s permission to speak her mind.

personally, I was anti-surgery in that case. It seemed to me that the amount of risk involved to remove a healthy organ (I perceived her uterus to be innocent until proven guilty, in that regard) outweighed the benefit of removing it, especially on an individual who couldn’t voice her opinion about it at all.

Q Grrl

November 9, 2007 at 11:00 am

Surgery or not? eh. Who gives a flip.

What needs addressing, from this community, is a base level of understanding of informed consent and autonomy. In one case, it was argued that a 14-year-old with the mental capacity of an 18-month-old should be accorded an adult level of autonomy; here it seems that, because of the cuteness-squee factor, no one seems troubled or inquisitive about the autonomy and consent of a 24-month-old. And in both cases, posters did not/do not seem overly concerned about quality-of-life.

Rather, feministe seems to take the stand that quality-of-life is really length-of-life.

antiprincess

November 9, 2007 at 11:50 am

What needs addressing, from this community, is a base level of understanding of informed consent and autonomy. In one case, it was argued that a 14-year-old with the mental capacity of an 18-month-old should be accorded an adult level of autonomy; here it seems that, because of the cuteness-squee factor, no one seems troubled or inquisitive about the autonomy and consent of a 24-month-old. And in both cases, posters did not/do not seem overly concerned about quality-of-life.

I think the difference is that in Lakshmi’s case, without the surgery she will surely die. With the surgery (providing it’s successful), she will live – who knows for how long, but she’ll live. In Katie’s case, without the surgery, she will live. With the surgery (providing it’s successful), she will also live, but the risks involved in removing an otherwise healthy organ which is useful in the maintenance of other bodily functions seem to be too great to make the surgery worth it. A hysterectomy won’t help Katie walk, or communicate verbally, or do any of the things that are normally considered, I guess, “quality of life”. Because of that, to me, it does seem a matter of violating Katie’s bodily integrity, and to no good end.

and in Lakshmi’s case, I guess unless we ask her herself, we won’t know if she’s in great pain all the time as a result of the surgery she had when she was two.

but, you know, I’m not a disabled person (for the time being), nor a doctor. so my opinion is not even worth the bandwidth. I get that. I am not the Great Line-drawer.

But I can listen to disabled people, and form some opinions I can live with based on that. so that’s what I did. if that seems to you to make a target worthy of your barbs, there’s nothing I can do about that.

Ah. I seem to have not made a very coherent argument. Of course the large brain and childbearing difficulties preceded most technology. However, technology such as c-sections and other methods of preventing death in childbirth may have prevented further evolutionary adaptations which might have led to humans eventually having an easier time in childbirth. For example, women with a tendency to give birth a little early and some secondary adaptation that led the earlier born fetuses to be able to survive as well as 40 weekers (earlier lung maturation?) might have had an advantage in a world in which there was no technology to assist birth (slightly smaller heads leading to less chance of obstructed labor, etc). This sort of adaptation might eventually have led to people in whom normal pregnancies lasted only 7-8 months and so had an easier time giving birth without losing adult cranial capacity. Or maybe not. It’s just hard to say with evolution.

Evolution produces selective pressure for big brains (for thinking) and narrow hips (for efficiency of upright motion). We’ve got as short a gestation time as we can manage, but beyond that, the conflict leads to a trade-off between the evolutionary benefits of surviving childbirth while having hips narrow enough to walk/run efficiently and the evolutionary benefits of having children with big brains.

Nonetheless, the trade off is a bad enough one that further evolution might be possible–that is, women with mutations that allowed them to give birth more easily might have a great enough reproductive advantage to become dominant in the population.

Evolution is amoral, and women suffer and die because of it.

Definitely. I never have understood people who run around claiming, for example, that we should all go off and give birth by ourselves as “nature intended”. Nature is not your friend. Treat it with respect and caution.

Ahhhh, so Q Grrl was being sarcastic. Now I have egg on my face! Thanks for clarifying, people.

I am not going to fall into the trap of refighting an old debate; I didn’t read a lot of the stuff about the Ashley X case because it was upsetting me too much. I can see from your comment, Q Grrl, that you don’t speak the language that people who are versed in the disability rights movement speak, so I can see how you might have put people’s backs up. It may be somewhat analogous to people who enter feminist discussions without speaking feminist language, and are assumed to be misogynists rather than merely ignorant.

But to address your clarifying comment, I agree that it would be desirable to thrash out what people really understand by informed consent, and what the exceptions are. I think that would be a very difficult discussion to have sensitively; a lot of disabled people have horrific experiences with the assumption that they are incapable of making decisions and therefore consent doesn’t apply to them. The fact that it’s a difficult discussion doesn’t mean it wasn’t worthwhile to ask the question, of course.

Dianne

November 9, 2007 at 12:16 pm

Rather, feministe seems to take the stand that quality-of-life is really length-of-life.

I’m not feministe or the great line drawer or anyone else in particular, but I can’t imagine how dragging around the headless body of your twin, being unable to walk or urinate normally, and living in hiding from circuses that want to take you away for display is a quality-of-life advantage over being able to walk and play normally, regardless of the length-of-life issue.

here it seems that, because of the cuteness-squee factor, no one seems troubled or inquisitive about the autonomy and consent of a 24-month-old.

No. Not even a little bit. Please do not assume that because I – and others – find Lakshmi charming and at the same time think that life-saving surgery was appropriate have somehow not thought through our position. As I said before, there are numerous articles, all over the web, detailing the dangers of Lakshmi’s condition to her long-term health. That Lakshmi is adorable is entirely unrelated.

And in both cases, posters did not/do not seem overly concerned about quality-of-life.

That sentence is a classic case of ignorant, ableist rhetoric. Unfortunately, it’s also quite a common position; non-disabled people routinely underrate the quality of life of people with disabilities, and – as you have done – assume that people with disabilities per se have a lower quality of life. It is dangerous in the extreme to judge another person’s quality of life without knowing what that person experiences.

Q Grrl

November 9, 2007 at 5:51 pm

That sentence is a classic case of ignorant, ableist rhetoric. Unfortunately, it’s also quite a common position; non-disabled people routinely underrate the quality of life of people with disabilities, and – as you have done – assume that people with disabilities per se have a lower quality of life. It is dangerous in the extreme to judge another person’s quality of life without knowing what that person experiences.

Of for crimminey’s sake. I have not assumed people with disabilities have a “lower” quality of life. I have observed that the majority of posters here, on this board, equate length of life with quality of life.

Lakshmi looked so freakin’ cute because at 24 months old, she was happy with her conjoined twin. I would love to see how she looks in the months to come and what the overall toll on her quality of life (and her maturing desire to have a say in that) will be. I would like to think she will remain as bright and happy. But we don’t know, do we, what that twin meant to her and to her life, even if it was medically life-threatening.

And please don’t assume you know anything about my body and its abilities and disabilities.

Q Grrl

November 9, 2007 at 5:59 pm

FTR: my views on quality of life stem from my multiple years of working for researchers on ethical issues regarding end-of-life care. The framing for quality-of-life was that the end of life should be in accordance with the manner in which the patient had led her/his life. Respect was given to autonomous choices even when those choices went against popular medical treatments, curative treatments, or palliative care.

The stress that I make, that is obviously being misinterpreted, is that it is the individual who should have the say in defining the quality of her/his life. Even if the self-defined quality shortens the length of life. Even if that quality is life-threatening.

Mnemosyne

November 9, 2007 at 6:45 pm

The framing for quality-of-life was that the end of life should be in accordance with the manner in which the patient had led her/his life. Respect was given to autonomous choices even when those choices went against popular medical treatments, curative treatments, or palliative care.

That framing makes sense for someone who has already had a long life and can rationally decide whether or not they want that life to continue.

That framing makes no sense for someone who is 2 years old and will die unless she is operated on. If a baby is born with a congenital heart defect that will kill it by 6 months of age, do we refuse to operate in the hope that the child will develop speech skills and rationality and tell us whether or not it wants the heart operation before it dies?

And please don’t assume you know anything about my body and its abilities and disabilities.

I certainly did not do that, and did not mean to give you that impression. I am well aware that there exist people with disabilities who espouse ableist rhetoric. We are large, we contain multitudes, and all that.

Q Grrl, thanks for clarifying in comment 90. It’s really important to consider the quality of life issues you mention, in terms of patient autonomy around end of life care. And it sounds like you’re an expert in that area.

The problem is that in many cases, the opposition of quality of life versus length of life is used as a superficially polite way of introducing a discussion about whether disabled people should be murdered or “allowed” to live. That’s the reason why you will encounter anger from disability rights activists if you use that phrase without providing sufficient context. For many disabled people, it has some pretty scary connotations.

Rachel at 88, good for you being ready to jump in and cut off what looked like the beginning of a noxious and ableist discussion before it could get going. That doesn’t always happen in Feministe comment threads, and it’s refreshing to see that political awareness here.

The problem is that in many cases, the opposition of quality of life versus length of life is used as a superficially polite way of introducing a discussion about whether disabled people should be murdered or “allowed” to live. That’s the reason why you will encounter anger from disability rights activists if you use that phrase without providing sufficient context. For many disabled people, it has some pretty scary connotations.

Yes, yes, yes. This bears repeating. Nearly all of the discussions of assisted suicide focus heavily on “quality of life” and not on “quality of care” – which might be more productive.